The Constitutional Right to Make Medical Treatment Decisions: A Tale of Two Doctrines

The Supreme Court has taken very different approaches to the question of whether individuals have a right to make autonomous medical treatment choices depending on the context.  For example, in cases concerning the right to choose partial-birth abortion and the right to use medical marijuana, the Court reached radically different results based on radically different reasoning.  More recent developments, including the decision in Gonzales v. Carhart, have only highlighted the doctrinal confusion and the need for a resolution.  In light of this pressing need, this Article views all of the constitutional cases touching on medical treatment decisions as one body of doctrine.

This new perspective reveals that there are in fact two distinct lines of constitutional doctrine touching on the right to make medical treatment decisions: (1) the “public health” line of cases, which emphasize the police power of the state over individual rights, and (2) the “autonomy” line of cases, which emphasize individual bodily integrity and dignity interests.  These lines of cases have developed in parallel, appearing to represent airtight doctrinal categories while in fact addressing the same fundamental question.  In addition, courts have applied varying degrees of deference to legislative determinations of medical fact without any logical consistency, perhaps based on largely superficial determinations about what type of case is before them.  This Article concludes that a constitutional right to protect one’s health should be consistently recognized; that the recognition of this right should not be artificially limited by excessive deference to legislative findings of medical fact; and that this right will have to be carefully balanced against the state’s real and legitimate interest in regulating the practice of medicine to protect the public.